Saturday, September 18, 2010

Excercise Induced Amenorrhea Leads To Poor Health & Infertility

QUESTION: I have been over exercising for about 10 years now. I get my period fine on birth control pills but when off birth control, I do not get it. I have been off it now for 6 months because the pills are expensive. Is this harmless not to get my period because of over exercising? I got a scan back in June and my gyno ruled out polycystic ovarian disorder. Since I know it's from the exercising and don't want to cut back, could this cause a problem with my fertility? What if I wanted to get pregnant right now? Would that even be possible? Thank you. N. from the U.S.


Hello N. from the U.S.,

If in fact the reason why you are not getting a period is because you have "exercise induced amenorrhea", that is the result of a dysfunction of the hypothalamus. It is detrimental to your health because, you are not forming the hormones that your body needs. The purpose of the birth control pill was not mainly to have a period, it is not needed in a person who is not making a uterine lining, but the birth control pill gives you the essential hormone estrogen. In addition, the hypothalamus is important for production of other hormones as well including thyroid hormone.

In terms of your fertility, your ovaries will be shut down so that you will have difficulty getting pregnant unless you decrease your exercising so that you have normal ovarian function (have natural periods) or you use fertility medications to replace the hormones the hypothalamus is not producing, to stimulate the ovaries to ovulate.

So, I know that you are an exercise junkie, but keep in mind that instead of making you more healthy, it may actually be more detrimental to your health in many ways, including achieving pregnancy.

Follow-up Question:

You mentioned the hypothalamus being important for the production of hormones including the thyroid, well I have an underactive thyroid and have been taking Levoxyl for at least 5 years now. Is this giving me the hormones I need? Also, I explained not getting my period to my OBGYN and after a scan of my area, he told me nothing was wrong. Why do you think he would say that when he knows of my period problems?

Follow-Up Answer:

Hi Again,

Adequate levels of thyroid hormone is measured by a blood test. We usually use TSH. If your thyroid replacement is adequate, the TSH levels should be in the normal range.

A vaginal ultrasound is only for anatomical abnormalities. It can see the ovaries and uterus, but cannot diagnose ovulation or hormonal problems. That is done by other testing as mentioned previously. If your doc only checks you out by doing an ultrasound, he is inadequately evaluating you for menstrual problems. Most menstrual problems are caused by hormonal problems, as mentioned previously. At least by the ultrasound you know that your ovaries, tubes and uterus are normal, but you don't know anything more than that. So from that point of view, anatomically nothing is wrong, but that is only anatomically. I would suggest you find a better doctor!

Good Luck,

Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
Monterey, California

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